Telemedicine use spikes during natural disasters

Nemours CareConnect is a telemedicine service available to Floridians. (Nemours Children's Hospital)

If Dr. Timothy Hendrix had any lingering doubts about telemedicine, they were erased during last year’s hurricane season.

As Central Florida began to brace for the arrival of Hurricane Irma in September, and doctors’ offices and urgent care centers closed, Nemours Children’s Hospital and Florida Hospital decided to offer their telemedicine services for free.

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Both services were flooded with calls from people seeking a virtual visit with a doctor.

There was a 554 percent jump in the number of people who installed the Nemours’ CareConnect app during the days before, during and after the hurricane.

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“We saw 270 kidsduring the day-and-a-half before and the day-and-a-half after the hurricane,” said Carey Officer, operational vice president of Nemours CareConnect and the Center for Health Delivery Innovation at the health system.

Florida Hospital’s eCare went from an average of four to five calls a day to 40 to 50 a day, said Hendrix, medical director of Florida Hospital Centra Care urgent care centers.

Hendrix has been practicing medicine for a quarter century and until two years ago, when Florida Hospital introduced its eCare consumer telemedicine service, his patient exams involved the actual presence of the patients in his office.

“I was resistant to the whole idea of eCare,” Hendrix said. “I’m an old-school doctor.”

But then in the days leading up to and after Hurricane Irma, he saw how a virtual doctor visit was the saving grace for the worried parents or the elderly who couldn’t access their doctors.

“It really made me realize the potential of [telehealth] in medicine and the potential ways we can use technology in unique situations like natural disasters,” said Hendrix. “I’m a total convert.”

Neither telemedicine is new, nor is its use during natural disasters. But advancements in technology and widespread access to smartphones and tablets have pushed telemedicine beyond the hospital walls and available to the masses.

Most current telemedicine services are provided via secure apps. Not all insurance companies cover telemedicine calls, so instead of waiting for new regulations and laws, the companies charge patients a flat fee, usually less than $100, to give them access to a provider. Depending on the service, the conversation may start with text messages and turn into a video call for further assessment.

The use of telemedicine has grown rapidly, with more than 1.2 million visits reported nationally in 2015, according to the policy think tank RAND Corporation.

Last year’s active hurricane season helped establish telemedicine as a viable alternative to in-person doctor visits during natural disasters.

In addition to Nemours and Florida Hospital, at least five other telemedicine companies, including Doctor on Demand, MDLIVE, Teladoc, American Well and LiveHealth Online also offered free services to consumers during the 2017 hurricane season, according to a study by RAND Corporation.

The study, which only analyzed data from Doctor on Demand during the month after Hurricanes Harvey and Irma, concluded that telemedicine services are a new way to deliver routine care to people in immediate aftermath of natural disasters.

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They study found that 63 percent of the more than 2,000 people who called Doctor on Demand after the hurricanes were first-time users.

It also highlighted another advantage to the use of telemedicine during disasters: out-of-state providers can be tapped to expand workforce quickly.

Doctors who were outside the affected states handled nearly half of the visits to Doctor on Demand, the study found.

Data show that most of the patient calls, during a disaster or other times, are for routine concerns such as common cold, respiratory problems, rashes and infections like pink eye.

“It's the same stuff that I see in the office, except that I sometimes asked them to do the exam. And you function more based on ‘Can I do this on this visit or should I ask them to see a doctor?’” said Hendrix.

He said he had to refer less than 5 percent of his eCare visits for a complete workup at the doctor’s office.

That said, telemedicine has its pitfalls.

Timely access to a pharmacy to fill prescriptions remains an issue. What if the patient is trapped at home? And what if all area pharmacies are closed? Can hospital pharmacies handle the outpatient demand?

And what if the patient — or doctor on call — doesn’t have access to power and Wi-Fi?

“[Telemedicine] is a good idea, but unfortunately, the very nature of a disaster makes the delivery of the care problematic,” said Dr. Antonio Velardi, director of critical care at Orlando Health’s Health Central Hospital.

In preparation for the hurricanes last year, Hendrix made sure that the eCare team had power and backup generators to get through the outage. He had access to Wi-Fi and could juice up his phone to answer calls, but still he had no power at home.